Authors:

Background: Rejuvenation procedures of the periorbital region and the forehead, with the eyebrow as a key structure, are often performed in plastic surgery. There is no common consent on the changes of aging in this region and the consecutive treatment options. This study was designed to support the body of literature with a broader data basis about the natural changes of eyebrow position and its shape. Read More

Authors:

Background: Upper eyelid dermatochalasis often triggers frontalis hyperactivity in an effort to elevate the upper lids away from the visual axis. Similarly, prior neuromodulator treatment of the brow depressors may cause false elevation of the brows, diminishing the extent of preoperative brow ptosis or dermatochalasis. Studies have quantified postoperative brow ptosis and recurrent dermatochalasis following upper blepharoplasty, but a methodology to predict the postoperative brow position remains to be elucidated. Read More

Authors:

Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Rome, Italy.

Context: Brow lifting is an essential element in the rejuvenation of the ageing face. Various surgical techniques have been described. Among these, the direct brow lifting is an easy and effective technique that is often neglected because the scar can remain visible. Read More

Periorbital rejuvenation requires a careful understanding of the interplay between the eyelids, brow, forehead, and midface. Reversing periorbital signs of aging requires a correction of volume loss, soft tissue ptosis, and skin changes. Many surgical and nonsurgical techniques exist to treat the aging periorbital region; however, careful consideration of the patient's complaints and existing anatomy is critical to achieving a safe and esthetically pleasing outcome. Read More

Authors:

Department of Plastic Surgery, Catholic University of Daegu, Daegu, South Korea.

The preoperative comprehensive evaluation of aging Asian patients seeking an Asian upper blepharoplasty and brow lift is imperative and should be performed meticulously. There are many methods of upper Asian face rejuvenation. Among them, the proper selection of operative technique is necessary. Read More

Surgical management of the aging upper face has taken on a critical role in total facial rejuvenation, with a variety of techniques available. The hallmarks of the aging upper third of the face and periorbital region most commonly manifest as rhytids, brow descent, prolapse of periorbital fat, dermatochalasis, and volume loss and hollowing. The surrounding structures should be assessed individually and their relationships carefully analyzed to guide selection of the appropriate treatment. Read More

Background: The brow and forehead are essential elements of the facial aesthetic architecture. Although frequently overlooked in youth, signs of facial aging are often most noticeable in the upper third of the face. Ptosis and loss of contour in the brows, along with temporal volume loss, sagging of periorbital tissue, and rhytides in the forehead, are common presenting complaints for aesthetic surgery. Read More

The sections on the face, neck, and brow include descriptions of facelift, neck lift, and open brow lift techniques, anesthesia, treatment goals, procedural approaches, complications, management, preoperative and postoperative care, rehabilitation, recovery, and outcomes. The approach to facial rejuvenation the midface and periorbital area is detailed. These operations are often and easily performed entirely with the use of local anesthesia and mild oral sedation. Read More

Fractional ultrapulse CO2 laser resurfacing improves photodamage, wrinkles, and acne scarring by ablation of damaged tissue with subsequent regeneration and remodeling of collagen. In this study, the authors examined the efficacy and safety of fractional CO2 laser and introduce a novel approach to the treatment of upper eyelid dermatochalasis. We treated 20 patients with low and moderate upper eyelid dermatochalasis. Read More

Authors:

Background: Corrugator resection is an integral part of periorbital rejuvenation and can be accomplished through the open coronal, endoscopic, or transpalpebral technique. While most authors concur about the importance of corrugator resection during brow lift surgery, considerable debate remains regarding the efficacy and technical ease of muscle resection with these approaches.

Objectives: The authors conducted a cadaver study to compare the completeness of resection of the corrugator muscle with the transpalpebral and endoscopic techniques. Read More

Authors:

Background: Various techniques have been described for periorbital rejuvenation and correction of the ptotic brow, including the coronal brow lift, the endoscopic brow lift, anterior hairline foreheadplasty in the subgaleal, subperiosteal, or subcutaneous planes, and the subcutaneous temporal brow lift.

Objectives: The authors present results from a series of 28 patients treated with subcutaneous temporal brow lift over nearly four years.

Methods: A retrospective chart review was conducted of 28 patients who were treated with subcutaneous temporal brow lift by the senior author (JDF) between July 2003 and January 2007. Read More

Authors:

The endoscopic midface lift procedure has evolved from experience with postreduction soft tissue repair after facial fracture fixation. The procedure elevates and repositions midface soft tissue, which descends with facial aging; as well, it can correct periorbital congenital abnormalities, such as exorbitism and lateral canthal displacement. The procedure has been refined by the senior author to employ a temporal endoscopic approach alleviating the need for a lower eyelid incision. Read More

Authors:

The rejuvenation of the African American periorbit is rooted in select modifications of traditional techniques. The African American patient presents with dynamic considerations and needs. Whereas this subset is at risk for pigmentation and scar concerns, the natural resistance to actinic damage makes rejuvenation efforts rewarding. Read More

Authors:

Brow lift and blepharoplasty are among the most commonly requested procedures in facial aesthetic surgery. The purpose of this article is to provide an overview of current concepts, including goals, surgical options, and outcomes for aesthetic improvement of the forehead and periorbital region. Preoperative patient assessment, anatomical and surgical concepts, advantages and disadvantages, and prevention and management of complications and expected results are discussed. Read More

Authors:

Department of Oral and Maxillofacial Surgery, University of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Purpose: This article examines the pathophysiology of periorbital aging and details a technique, autologous fat transfer, to restore a youthful appearance to the periorbital complex. The use of photographs taken of patients in their late teens or early 20s shows that the main changes of periorbital aging are consistent with volume loss more so than gravitational changes. This article reflects on the shortcomings of currently accepted surgical approaches to the rejuvenation of the periorbital region. Read More

Background: There exists some ambiguity regarding the exact anatomical limits of the orbicularis retaining ligament, particularly its medial boundary in both the superior and inferior orbits. Precise understanding of this anatomy is necessary during periorbital rejuvenation.

Methods: Sixteen fresh hemifacial cadaver dissections were performed in the anatomy laboratory to evaluate the anatomy of the orbicularis retaining ligament. Read More

Authors:

Background: The periorbital region is one of the first facial regions to show signs of aging. Traditional surgical approaches consisted of lifting and excisional procedures including brow lifts and blepharoplasties. Suboptimal results, however, have led surgeons to reassess their approach to the periorbita to address volume loss. Read More

Authors:

Hospital de Clinicas, University of Buenos Aires, Buenos Aires, Argentina.

Background: Brow elevation is one of the goals of surgical rejuvenation procedures. In this article, the authors evaluate the results of a frontotemporal suspension-fixation technique by means of temporoparietalis fascia/galeal/periosteal flap imbrication through an open or endoscopically assisted approach.

Methods: A total of 32 female patients aged between 44 and 72 years were operated on under local anesthesia and sedation. Read More

Background: This study was proposed to analyze the changes in shape and position of the eyebrow before and after botulinum toxin A injection using two different protocols for a periorbital rejuvenation.

Methods: The botulinum toxin A treatment was performed for brow-lift and effacement of crow's feet (group A), and for brow-lift and effacement of glabellar frown lines in addition to crow' feet (group B). To evaluate the change in brow shape and height, measurements of five points around the brow were taken before and after treatment. Read More

Results: Central forehead-lift was performed in 65% (57/88) of the women but in only 1 man (9%), with coronal and frontal trichophytic hairline approaches used in 28% (16/58) and 72% (42/58) of patients, respectively. Read More

Authors:

A simplified approach to subperiosteal midface rejuvenation is presented. The technique was developed through experience with 60 subperiosteal face lifts over an 8-year period. Because it does not involve a lower eyelid incision, there is no risk of ectropion, yet the midfacial structures and orbicularis oculi muscle can be elevated easily and precisely. Read More

Authors:

Medical University of South Carolina at Spartanburg, Spartanburg, SC, USA.

Learning Objectives: The reader is presumed to have a broad understanding of plastic surgical procedures and concepts. After studying this article, the participant should be able to: Physicians may earn 1 hour of Category 1 CME credit by successfully completing the examination based on material covered in this article. The examination begins on page 333. Read More

Authors:

Division of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.

The subperiosteal face lift described by Psillakis has been criticized for not showing a more dramatic improvement over conventional brow/face lift procedures. His approach also has a significantly high incidence of nerve injury. This study reports our anatomic findings and surgical modifications, which have permitted a significant improvement in the safety of execution and clinical results using the subperiosteal face lift concept. Read More

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